Network television is saturated with drug advertisements. They promise everything from freedom from nerve pain to the end of anxiety-ridden afternoons. Watching these commercials can make you feel like you’re not taking enough, or the right, medication.
In fact, nothing could be further from the truth.
Medication overload among older adults — also known as polypharmacy — is a real and devastating public health issue. As a report by the nonprofit Lown Institute noted, “Over the past few decades, medication use in the U.S., especially for older people, has gone far beyond necessary polypharmacy to the point where millions are overloaded with too many prescriptions and are experiencing significant harm as a result.”
Those harms have a real-life impact: Every day in America, 750 older adults are hospitalized due to side effects from one or more medications. And the Lown Institute predicts that in the next 10 years, 150,000 older adults will die prematurely due to medication overload.
As a practicing nurse who has long been concerned about medication problems among older adults, I’m committed to sounding the alarm about this problem. A survey conducted by WebMD in partnership with The John A. Hartford Foundation found that 50 percent of older adult respondents didn’t know that certain medications should be avoided, and 40 percent were not aware that some medications can affect memory and recall.
As We Age, We Metabolize Less Effectively
There’s a reason over-medication disproportionately impacts older adults. Normal aging leads to changes in some vital organ functions. A person’s lungs, kidneys and liver, for example, don’t work as efficiently with age. This means that an older person’s body metabolizes medication less effectively, putting them at greater risk for side effects.
The more medications you are taking, the higher the risk of those drugs interacting dangerously with each other. Multiple medications can cause confusion, lightheadedness and even internal bleeding — all dangerous and injurious conditions. Here are 10 medications that the American Geriatrics Society (AGS) says older adults should avoid or use with caution. Of course, every individual is different, so talk to your health care provider or pharmacist before stopping any medications.
Fortunately, a national movement of hospitals and health systems is tackling the medication overload problem. The John A. Hartford Foundation and the Institute for Healthcare Improvement’s Age-Friendly Health Systems initiative focuses on older patients’ medications as one element of a 4Ms framework that guides care. (The three other “Ms” are: focusing on what matters to older patients, promoting healthy mentation and improving mobility.)
Health systems participating in the initiative are not only addressing medication risks, but also working to ensure that medications don’t interfere with quality of life. For example, by asking about what matters most to an older patient, a doctor, physician assistant or nurse practitioner may recommend de-prescribing or changing a blood pressure medication that is making a patient too lightheaded to play with her young grandchildren.
When it comes to using medications safely and ensuring they don’t negatively impact your quality of life, speaking up is the most important thing you can do. Three in four older adults aren’t aware that they have the right to ask for, and receive, health care tailored to what they need and want. Medications can impair quality of life and that should always be questioned.
Thanks to organizations like the Lown Institute and AGS, raising your medication concerns should be a normal and key part of any health care visit. The National Institute on Aging also provides a helpful worksheet that you can fill in and bring to your next appointment. Advanced preparation will help you get your questions answered and the care you want, need and deserve.
Despite what the ads promise, talking to your doctor about what matters to you and the concerns you have about your medications can be even better than taking another pill to ensure you’re living your best life.
For more resources on age-friendly care, visit johnahartford.org/agefriendly.
(A version of this article, by Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, originally appeared on Next Avenue.)
Lown Institute: "Medication overload and older Americans," "Medication Overload: America’s Other Drug Problem."
Institute for Healthcare Improvement: "The Hidden Drug Problem of Older Adults: Medication Overload."
AGS Health in Aging Foundation: "Ten Medications Older Adults Should Avoid or Use With Caution."
The John A. Hartford Foundation: "Survey Finds Many Incorrectly Believe Depression, Dementia and Lack of Mobility are Inevitable."